Aspects of degenerative process escalating with age
As it is said, if there is birth, there is development, disease, degeneration and death. Degeneration is a part of life. We cannot stop degeneration but with effort we can reduce the pace of this degeneration. As medical science and technology is improving, so is the longevity of humans. This is also increasing the number of patients suffering from degenerative diseases.
Health, as defined by the World Health Organization (WHO), is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It is a universal law of nature that all- both humans and animals- want to seek pleasure and get rid of pain. The scenario of orthopaedic practice has changed tremendously in the last 40 years. Earlier, the patients were coming in OPD, mainly for the treatment of developmental deformity like club foot and congenital hip dislocation, paralysis due to infection like Polio and, TB and for fracture related complications but nowadays OPD attendance has diverted to treating the patients having degenerative problems, chronic musculoskeletal pain and complications of treatment in complex road traffic accidents. After recent advancement in the field, the problems caused due to infection and fractures have reduced significantly but not that of degeneration. Ageing is among the greatest known risk factors for most human diseases.
Degenerative joint disease which is also referred to as osteoarthritis (OA), is a common “wear and tear” disease that occurs when the cartilage that serves as a cushion in the joint becomes thin and deteriorates. This condition can affect any joint but is most common in knees, hips, hands and spine. Degenerative arthritis presents with swelling, pain, osteophytes (new bone formation) and deformities around the involved bone and joint. We should take a calcium rich, balanced diet and should do more physical work as far as possible on a daily basis. We should exercise regularly and should have regular 7-8 hours of sleep. For good health people should follow this acronym DEWS (Diet, Exercise, Work and Sleep). In addition to that people should do yoga on a regular basis.
Though there are many causes of deformity like fracture, polio, infection, developmental etc but here I would like to confine myself to the causes, prevention and treatment of deformities caused due to degenerative bone disease. Degenerative process is accentuated if a person is overweight and not taking a balanced and nutritious diet and having mal alignment of bone and joint because of any reason as mentioned earlier. As such any injury in the bone or joint if not treated well can give rise to deformities. To prevent these deformities one should avoid any injury. But, if it happens then it should be treated well. The goal of the treatment should be to achieve anatomical alignment of bone and joint during surgery especially in injuries involving the joint.
Osteoarthritis is a common cause of degenerative arthritis, which increases as the age advances. It is most common in lower limbs in the Indian population. Deformities of knee joints are very common in our population because we Indians traditionally squat or sit cross legged for most day to day activities. This habit is now changing to a certain extent particularly in the urban areas.
In early stage, these deformities can be corrected with exercise, splinting and corrective exercise and with physiotherapy; however large joints such as the knee joint can be better corrected by realignment surgery. The other surgery which is very common in osteoarthritis of the knee is total replacement of the joint which is called total knee replacement. Nowadays, knee surgery results are quite predictable and hence it has become a very popular surgery for knee osteoarthritis. The success of any surgery depends not upon type of surgery but on the correction of the mal-alignment. If we can achieve a balanced knee then the patient will have a predictable and a long lasting result.
Total hip replacement is usually done for osteoarthritis of the hip. Because of anatomical differences, its results are better in comparison to total knee replacement and here the goal of the surgery should be to have a stable hip with almost full range of motion so that the patient can squat and do cross legged sitting whenever it is needed. In our country none of the activities whether personal, professional or religious can be completed without squatting or cross legged sitting. Joint replacement surgery is quite successful but not that successful in India as in many developed nations. The reasons seem to be late presentation with gross deformities of joint and rarely if the patient develops post operative infection.
Backache is the second most common problem experienced by individuals after headache. It is estimated that everyone will have back pain at least once in their life time. Back pain is one of the main ailments afflicting the people in general and more so in the hills. Elderly patients usually present with degenerative spine disease resulting into spinal canal stenosis (narrowing of spinal canal) which presents with neurological claudication. Spinal stenosis patients can easily go up hills but it is difficult for them to come down hills. Other common cause of back pain is facet joint arthritis. The facet joints also degenerate with advance in age. Back becomes stiff on waking in the morning and gets relief after moving certain distance. Arthritic pain aggravates during bending and rotation.
When the patients of degenerative bone and joint diseases become symptomatic then in early stage, they can be treated conservatively with the use of heat, massage, exercises and mild painkiller drugs. But when this degeneration progresses these patients cannot be managed conservatively, then these patients are re-evaluated and are often candidates for surgery. The results of varied types of surgery are quite predictable nowadays. Surgeries are difficult and risky but its success completely depends on the severity of problem, skills of surgeon and the facilities available in the hospital.
(The writer is an orthopaedic surgeon based in Dehradun)
Monday, 24 August 2020 | Dr Gaurav Sanjay | Dehradun